Observations on the Treatment of Bipolar Disorder

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
Ostacher MJ. The evidence for antidepressant use in bipolar depression. J Clin Psychiatry. 2006;67(suppl 11):18-21. Abstract
Marken PA, Pies RW. Emerging treatments for bipolar disorder: safety and adverse effect profiles. Ann Pharmacother. 2006;40:276-285. Abstract
Simon NM, Otto MW, Wisniewski SR, et al. Anxiety disorder comorbidity in bipolar disorder patients: data From the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2004;161:2222-2229. Abstract
Baldessarini RJ, Tondo L, Hennen J. Treating the suicidal patient with bipolar disorder. Reducing suicide risk with lithium. Ann N Y Acad Sci. 2001;932:24-38. Abstract
Marken PA, Pies RW. Emerging treatments for bipolar disorder: safety and adverse effect profiles. Ann Pharmacother. 2006;40:276-285. Abstract
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Introduction

Bipolar disorder, which in the United States has a prevalence rate estimated at 1% to 3%,^[1] presents numerous challenges for clinicians. Not only are symptoms variable (the key feature of bipolar I disorder is the occurrence of a manic episode, while bipolar II disorder is characterized by at least 1 hypomanic episode in addition to recurrent major depressive episodes^[2]), but there is also the risk for relapse.

Recent research indicates that patients who spend longer periods of time in depressive episodes have a greater likelihood of relapsing to depression compared with mania and hypomania.^[3] Over 90% of patients who experience a single manic episode will experience some form of relapse.^[4]

There is also a high rate of comorbidity in bipolar disorder that often is difficult to treat. Studies have reported the rate of comorbid anxiety disorders as follows: 10.6% to 62.5% for panic disorder; 7.8% to 46.2% for social anxiety disorder; 3.2% to 35% for obsessive-compulsive disorder; 7% to 38.8% for posttraumatic stress disorder; and 7% to 32% for generalized anxiety disorder.^[5]

Coupled with increased risk for suicide (with rates reported as high as 2% per year)^[6] and issues of medication nonadherence (one the most common reasons for relapse of this condition),^[7] clinicians face a number of barriers in treating this patient population.

Many patients who suffer ongoing symptoms and relapse are unable to maintain personal and professional relationships. One study investigating recovery following the first episode of a major affective disorder (in the study, 72.6% were bipolar and 27.4% had major depressive disorder with psychotic features) found that even though 98% of the patient population achieved syndromal recovery within 2 years, only 38% achieved functional recovery. Functional recovery meant that patients were able to regain the occupational and living situations equivalent to those they held prior to their episode. These results suggest that occupational functioning following an episode has a significant impact on long-term functional recovery.^[8]

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The Financial and Emotional Impact of Bipolar Disease

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Faculty and Disclosures

Observations on the Treatment of Bipolar Disorder

Introduction